Unique Plan Description: GYNONC Enhanced Recovery Robotic Post-Op EKM
Plan Selection Display: GYNONC Enhanced Recovery Robotic Post-Op
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2017-02-27 08:34:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-11-14 15:44:26
Available at all facilities: Yes

GYNONC Enhanced Recovery Robotic Post-Op EKM
Vital Signs
	Vital Signs
		T;N, Routine post op
Activity
	Up in Chair
		T;N, TID
	Ambulate
		With assistance, TID
			Comment: start day of surgery
Diet
	Regular Diet
		T;N
Laboratory
	CBC with Diff
		T+1;0400, Routine, spec type = Blood
	Basic Metabolic Panel
		T+1;0400, Routine, spec type = Blood
	Glucose POC - RN
		Q6H-Sch
IV Solutions
	Discontinue IV Fluids
		See Order Comments
			Comment: Prior to leaving PACU
Medications
	Tylenol
		1,000 mg, Tab, By Mouth, Q6H, T;N+360
			Comment: Please be advised that the nonnarcotic pain meds are scheduled and not PRN.  Please give to the patients even if not in pain, do not give both oral and IV APAP, start 6 hr after any pre-op/intra-op dose.
	acetaminophen 10 mg/mL intravenous solution
		1,000 mg, Solution-Injection, IVPB, Q6H, PRN for see comment, T;N+360
			Comment: Administer only if unable to take oral or rectal formulation; convert to oral medication as soon as possible and discontinue IV order, start 6 hours after any pre-op/intra-op dose.
	ibuprofen
		800 mg, Tab, By Mouth, Q8H, see comment, T;N+720, 72 hr
			Comment: Do not give if systolic blood pressure is < 90mm Hg or if serum creatinine is greater than 1.5mg/dL (or creatinine clearance < 50ml/min).  Notify MD of any dose not given with a note in the chart.  Please be advised that the nonnarcotic pain meds are scheduled and not PRN.  Please give to the patients even if not in pain. Please give on scheduled basis. Start 12 hours after any preoperative/intraoperative NSAID, and 6 hours after any postoperative IV ketorolac dose
	ketorolac injectable
		15 mg, Injection, IV PUSH, Once, PRN, pain-moderate
			Comment: Do not give if systolic blood pressure is < 90mm Hg or if serum creatinine is greater than 1.5mg/dL (or creatinine clearance < 50ml/min).  Notify MD of any dose not given with a note in the chart Comment: Please be advised that the nonnarcotic pain meds are scheduled and not PRN.  Please give to the patients even if not in pain. Start 12 hours after any preoperative/intraoperative NSAID, and do not give within 8 hours of any postoperative ibuprofen dose
		30 mg, Injection, IV PUSH, Q6H, T;N+720, 2 Dose(s)/Time(s)
			Comment: Do not give if systolic blood pressure is < 90mm Hg or if serum creatinine is greater than 1.5mg/dL (or creatinine clearance < 50ml/min).  Notify MD of any dose not given with a note in the chart Comment: Please be advised that the nonnarcotic pain meds are scheduled and not PRN.  Please give to the patients even if not in pain. Start 12 hours after any preoperative/intraoperative NSAID, and do not give within 8 hours of any postoperative ibuprofen dose
	traMADol
		25 mg, Tab, By Mouth, Q6H, PRN, pain-mild
		50 mg, Tab, By Mouth, Q6H, PRN, pain-moderate
		If the patient has received an intrathecal/epidural anesthesia will order PO/IV opiods for the first 24hrs.(NOTE)*
	oxyCODONE
		5 mg, Tab, BY MOUTH, Q4H, PRN, pain-severe
			Comment: for pain rated 4 or greater and greater than patient stated comfort goal after scheduled medications given. Give for pain rated 4-6.
	naloxone
		0.4 mg, Injection, IV PUSH, Q5MIN, PRN, see comment
			Comment: If patient has received opiate agents in the past 24 hours and/or if patient becomes somnolent with minimal or no response to stimuli or respiratory rate is 8 or less per minute.  RN may administer naloxone prior to contacting MD.  Notify MD immediately upon administration of naloxone.
Antiemetics
	ondansetron
		4 mg, Tablet-Disintegrating, By Mouth, Q6H, PRN for nausea and/or vomiting
		4 mg, Injection, IV PUSH, Q6H, PRN for nausea and/or vomiting
	Reglan
		10 mg, Injection, IV Push, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron, phenothiazine or other anti-nausea medications ineffective. Avoid in patients >65 yrs
		10 mg, Injection, IM-Intramuscular, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron, phenothiazine or other anti-nausea medications ineffective Avoid in patients >65 yrs
	Benadryl
		12.5 mg, Injection, IV Push, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron, ineffective; avoid in patients > 65yo
	prochlorperazine
		10 mg, Injection, IV Push, Q6H, PRN, nausea and/or vomiting
			Comment: Give if ondansetron ineffective and if no history of seizures;
	Colace
		100 mg Capsule BY MOUTH BID
	Milk of Magnesia 8% oral suspension
		30 mL, Suspension, By Mouth, BID, PRN for constipation
Patient Care

	Resuscitation Status
		T;N, Full Code
		T;N, No Code
	Discontinue Urinary Catheter
		T;N, Foley
			Comment: on arrival to unit if still in place.
	Foley Catheter
		Foley, To dependent drainage, Pt. undergoing abdominal/pelvic surgery
	Do Not
		Remove foley
	VTE Advisor
		Gynecologic surgery
	Incentive Spirometer
		T;N, Q1H, Instructions, 10x per hour
	Intake and Output
		Q4H-Sch
			Comment: record urine output q4h
	Notify MD
		For Urine Output less than 10ml in 1 hrs
	Patient to Chew Gum
		To increase GI motility
	May Shower
		T;N
			Comment: use CHG soap or wipes
	Dressing Care
		T;N, Remove, Bandaid
			Comment: leave steri strips on for 7 days
Therapies
	Consult Physical Therapy, Evaluate and Treat
		Reason to See: Progressive Ambulation
	Consult Occupational Therapy, Evaluate and Treat
		Reason to See: Activities of Daily Living
Consults/Follow-up
	Consult Palliative Care
		
	Consult Dietitian
		
			Comment: To provide high protein options prior to discharge

Peripheral Lock - Access
Medications
	sodium chloride 0.9% flush injectable soln
		10 mL Syringe IV PUSH BID
		10 mL, Syringe, IV PUSH, Q5MIN, PRN, IV line flush
	lidocaine 1% injectable solution (MH/WH/FH)
		0.1 mL, IntraDermal, Q1H, PRN, see comment
			Comment: For IV start
	sodium chloride bacteriostatic 0.9% injectable soln
		0.1 mL, Injection, IntraDermal, Q1H, PRN, see comment
			Comment: For IV start, use if patient has lidocaine allergy.
	Sodium Chloride 0.9% IVPB Flush
		25 mL, IVPB, Q1H, PRN, IV line flush, 5 min(s)
			Comment: Use if medication not compatible with primary line or there is no primary line;  infuse 25mL.
Patient Care
	Peripheral Lock-Insert
		T;N

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase